Provider Demographics
NPI:1033177324
Name:GREEN, BETH ANN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:BETH ANN
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BETH ANN
Other - Middle Name:MARIE
Other - Last Name:FILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:RR 3 BOX 114
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9415
Mailing Address - Country:US
Mailing Address - Phone:570-378-3242
Mailing Address - Fax:570-307-1771
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1620
Practice Address - Country:US
Practice Address - Phone:570-307-1769
Practice Address - Fax:570-307-1771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001143L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist